PRE-OP DIAGNOSIS: Patient desires long-term, reversible contraception.
POST-OP DIAGNOSIS: Same
PROCEDURE: Nexplanon placement
Performing Physician:
Supervising Physician:
PROCEDURE:
-Written and verbal informed consent obtained, risks discussed included: bleeding, irregular menses, infection, pain/discomfort, cost for removal.
-Written and verbal informed consent obtained, risks discussed included: bleeding, irregular menses, infection, pain/discomfort, cost for removal.
-The appropriate timeout was taken and the patient’s non-dominant hand was identified.
-Patient was instructed to lie supine on the examination table with her non-dominant arm flexed at the elbow and externally rotated so that her hand was underneath her head (or as close as possible).
-The insertion site was identified on the inner side of the non-dominant upper arm, 8 –10 cm from medial epicondyle of the humerus and 3-5 cm posterior to the sulcus (groove) between the biceps and triceps muscles. The insertion site was marked with a sterile marker.
-A second spot (guiding mark) was made with the sterile marker 5 cm proximal (toward the shoulder) to the mark of the insertion site to serve as a direction guide during the Nexplanon insertion.
-The insertion site was confirmed as the correct location on the inner side of the arm.
-The skin was cleaned from the insertion site to the guiding mark with an antiseptic solution (Betadine / Chloraprep) and draped in a sterile fashion.
-The skin was cleaned from the insertion site to the guiding mark with an antiseptic solution (Betadine / Chloraprep) and draped in a sterile fashion.
-Anesthesia was achieved by injecting 2 mL of 1% lidocaine (without epinephrine) just under the skin along the planned insertion tunnel. Anesthesia confirmed.
-The skin was punctured with the tip of the Nexplanon trocar needle slightly angled less than 30°. The needle was inserted until the bevel (slanted opening of the tip) was just under the skin (and
no further).
no further).
-The applicator was then lowered to a horizontal position. While lifting the skin with the tip of the needle, the needle was inserted to its full length. Mild resistance was felt but no excessive force was used. The needle slid in easily.
-The applicator was kept in the same position with the needle inserted to its full length. The free hand was used to keep the applicator in the same position. Then the purple slider was unlocked by pushing it slightly down. The purple slider was then moved fully back until it stopped, delivering the Nexplanon capsule subcutaneously. The trocar was removed from the insertion site.
-Nexplanon capsule was palpated by provider and patient to assure satisfactory placement.
-A Bandage and a pressure pressing were applied to the area. Patient to keep the pressure dressing for 24 hrs and the bandage for 3-5 days.
-Anticipatory guidance, as well as standard post-procedure care, was explained.
-Return precautions are given. The patient tolerated the procedure well without complications.
-Estimated blood loss was less than 0.5 mL
-Anticipatory guidance, as well as standard post-procedure care, was explained.
-Return precautions are given. The patient tolerated the procedure well without complications.
-Estimated blood loss was less than 0.5 mL
Follow-up: 4-6 weeks, at which time the placement will be checked.
Helpful Links
http://www.venturafamilymed.org/cerner-ehr-tips/autotexts/nexplanon-insertion-procedure-note
https://www.drugs.com/pro/nexplanon.html (This site has some excellent images)